Pulmonary block 3 (Q92-125)

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Questions 92 and 93: Click on the checkbox first, then the lettered item: (92) A 24 year old female who goes to the emergency room because of the onset of severe respiratory distress reports having taken aspirin for a headache.
(93) Previous exposure to asbestos during construction projects is reported in a 61 year old male who has increasing dyspnea over several years.
A Fibrous pleural plaques
B Pulmonary atherosclerosis
C Bronchoconstriction
D Bronchiolitis obliterans
E Necrotizing vasculitis
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Questions 94 and 95: Click on the checkbox first, then the lettered item: (94) A 40 year old man presents with increasing cough and dyspnea for several months. He also has an increased serum urea nitrogen and creatinine. A chest radiograph shows multiple bilateral small nodules. A transbronchial biopsy shows necrotizing granulomatous inflammation involving small peripheral arteries.
(95) A 55-year-old male with an enlarged right heart on chest radiograph has increasing peripheral edema, but no dyspnea or cough. He is afebrile. A lung biopsy demonstrates peripheral pulmonary arteries with fibrosis and recanalization.
A Goodpasture's syndrome
B Wegener's granulomatosis
C Idiopathic pulmonary hemosiderosis
D Acute bacterial pneumonia
E Recurrent multiple pulmonary emboli
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Questions 96 and 97: Click on the checkbox first, then the lettered item: (96) Bronchioloalveolar carcinoma.
(97) Pulmonary hamartoma.
A Early and widespread metastases
B Polarizable crystals
C Coin lesion (discreet and localized)
D Parathyroid hormone-like activity
E Pneumonia-like consolidation
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Questions 98 and 99: Click on the checkbox first, then the lettered item: (98) Chronic bronchitis.
(99) Hypersensitivity pneumonitis.
A Aspirin sensitivity
B Farmer's lung
C Coal-mining
D Chronic, necrotizing infection
E Long-term persistent cough with sputum production
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Questions 100 and 101: Click on the checkbox first, then the lettered item: (100) A non-productive cough with fever and dyspnea but no hemoptysis are present in a 30-year-old male. A chest radiograph reveals bilateral perihilar infiltrates.
(101) Upper lobe cavitary lesions are seen radiographically in a 45-year-old male who has had a fever for several weeks.
A Goodpasture's syndrome
B Asbestosis
C Cor pulmonale
D Pneumocystis carinii pneumonia
E Secondary tuberculosis
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Questions 102 and 103: Click on the checkbox first, then the lettered item: (102) Coccidioidomycosis
(103) Histoplasmosis
A Phoenix, Arizona
B Cheyenne, Wyoming
C Seattle, Washington
D Natchez, Mississippi
E Miami, Florida
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Questions 104 and 105: Click on the checkbox first, then the lettered item: (104) A 35 year old male is involved in a motor vehicle accident and sustains injuries including blunt trauma to the chest and abdomen, right ischial fracture, right femoral fracture, and left tibial fracture. He is taken to surgery and the fractures are stabilized. Postoperatively he is doing well until two days after admission, when he suddenly develops severe dyspnea. Despite resuscitative measures, he dies. What special stain performed on a section of the lung at autopsy would most help to elucidate the probable cause for these findings:
(105) A 35 year old woman has dyspnea worsening over the past two weeks. She is coughing up large amounts of sputum that resemble thick, gelatinous cream. She had a similar episode a year ago. A chest radiograph shows diffuse pulmonary opacification. A lung biopsy is performed, and microscopically every alveolus is filled with an acellular exudate. Lung lavage is performed and she recovers. Which of the following special stains performed on the biopsy will be most useful to demonstrate the nature of this exudate and the underlying disease:
A Acid fast stain
B Gomori methenamine silver (GMS) stain
C Periodic acid-Schiff (PAS) stain
D Oil red O stain
E Trichrome stain
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Questions 106 and 107: Click on the checkbox first, then the lettered item: (106) A 21 year old man has the sudden onset of hemoptysis. A chest radiograph shows scattered infiltrates in both lungs. A sputum gram stain and culture show normal flora. Sputum cytology shows numerous red blood cells, but no neutrophils and no atypical cells. He then develops hematuria. Laboratory findings include serum urea nitrogen of 38 mg/dL with creatinine 4.5 mg/dL. A transbronchial lung biopsy is performed and shows extensive intra-alveolar hemorrhage. By which of the following mechanisms is this disease being mediated:
(107) Each Spring, a 15 year old male develops rhinorrhea with sneezing and stuffy nose. He also experiences episodes of wheezing and coughing during which he has difficulty breathing. During the most recent episode, physical examination revealed lungs clear to auscultation. He coughed up a large glob of mucus. A CBC showed WBC count of 9150/microliter with differential of 66 segs, 4 bands, 15 lymphs, 7 monos, and 8 eosinophils, Hgb 14.4 g/dL, Hct 44.7%, MCV 90 fL, and platelet count 310,000/microliter. By which of the following mechanisms is this disease being mediated:
A Mast cell degranulation
B Complement activation
C Antigen-antibody complexes
D CD4 lymphocyte infiltration
E Neutrophilic exudate
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Questions 108 and 109: Click on the checkbox first, then the lettered item: (108) A productive cough with yellowish sputum production has been increasing for several days in a 40 year old male, who has continued working 16 hours a day to produce a new television show. He has a fever to 38.9 C. Gram stain of the sputum shows 4+ gram positive cocci in chains.
(109) A 42 year old male received an orthotopic cardiac transplant two months ago and has had mild acute rejection treated with increasing immunosuppressive therapy. He has developed a cough with fever and headache. A chest radiograph reveals consolidation involving most of the right mid-lung. A bronchoalveolar lavage reveals long, filamentous, gram positive organisms to be present.
A Acute abscessing bronchopneumonia
B Chronic abscessing pneumonia
C Interstitial pneumonitis
D Lobar pneumonia
E Miliary granulomata
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Questions 110 and 111: Click on the checkbox first, then the lettered item: (110) A 2-year-old child has croup.
(111) An 18-year-old marine in boot camp develops a pharyngitis followed by a meningitis.
A Group A beta-hemolytic streptococcus
B Corynebacterium diphtheriae
C Hemophilus influenzae
D Bordatella pertussis
E Neisseria meningitidis
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Questions 112 and 113: Click on the checkbox first, then the lettered item: (112) A 35-year-old non-smoking female has had a chronic cough for years, sometimes accompanied by fever and sputum production. A chest radiograph now reveals consolidation of the left mid-lung field. A bronchogram demonstrates bronchial dilation and sacculation involving the first segmental bronchus and branches extending to the left lingular region.
(113) A chest radiograph reveals a 3-cm right upper lobe peripheral coin lesion in a healthy 44-year-old male non-smoker.
A Pulmonary hamartoma
B Bronchial carcinoid
C Mesothelioma
D Metastatic adenocarcinoma
E Large cell undifferentiated carcinoma
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Questions 114 and 115: Click on the checkbox first, then the lettered item: (114) A 50 year old male has a chronic, non-productive cough along with dyspnea that has worsened over several months. He does not have hemoptysis. A chest radiograph reveals a diffuse reticulonodular pattern along with hilar adenopathy. A transbronchial lung biopsy reveals non-caseating granulomata. Cultures and special stains for organisms are negative.
(115) At autopsy, the lungs of a 65 year old male have multiple 0.1 to 0.7 cm firm nodules scattered throughout, but more confluent in upper lobes. These nodules demonstrate the microscopic appearance of many polarizable needle-shaped crystals.
A Silicosis
B Farmer's lung
C Berylliosis
D Anthracosis
E Byssinosis
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Questions 116 and 117: Click on the checkbox first, then the lettered item: (116) A 49 year old female with a history of an infiltrating ductal carcinoma of the left breast treated with mastectomy and chemotherapy 3 years ago now has a profound weight loss and increasing dyspnea.
(117) A 44 year old male has a history of rheumatic heart disease with mitral, aortic, and tricuspid valve stenosis seen on echocardiography.
A Pneumothorax
B Hydrothorax
C Chylothorax
D Hemorrhagic effusion
E Empyema
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Question 118 Diffuse interstitial fibrosis can be part of the pathogenesis of each of the following conditions EXCEPT:
A Centrilobular emphysema
B Diffuse alveolar damage
C Sarcoidosis
D Bronchopulmonary dysplasia
E Scleroderma
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Question 119 A 3200 gm female neonate is delivered at term to a 23 year old primagravida following an unremarkable pregnancy. Ultrasound at 20 weeks had shown normal development for age, with major organs identified and normal in size. Amnionic fluid volume was normal. An alpha-fetoprotein was 1.1 multiples of the mean (MoM). At birth, the baby had Apgar scores of 7 and 9 at 1 and 5 minutes. Both baby and placenta demonstrated a greenish staining. Which of the following conditions is most likely to explain respiratory distress that develops in this neonate:
A Down syndrome
B Cytomegalovirus infection
C Cystic adenomatoid malformation
D Pulmonary sequestration
E Meconium aspiration
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Question 120 A 33 year old female complains of a cough for several months, along with shortness of breath. A chest radiograph demonstrates multiple small nodules distributed throughout all lung fields, but more numerous in the upper lobes. A transbronchial biopsy is performed, and examination of the tissue reveals nodular aggregates of Langerhans cells with eosinophils, lymphocytes, plasma cells, and some fibroblasts with collagenization. These findings are most characteristic for:
A Wegener's granulomatosis
B Hypersensitivity pneumonitis
C Pulmonary eosinophilic granuloma
D Goodpasture's syndrome
E Bronchial asthma
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Question 121 The best procedure to diagnose a pulmonary opportunistic infection in a bone marrow transplant patient with diffuse lower lobe infiltrates on chest radiograph is:
A Sputum cytology
B Bronchial washing
C Open lung biopsy
D Fine needle aspiration
E Bronchoalveolar lavage
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Question 122 An 18 month old child is feeding poorly for a couple of days, and then has rhinorrhea with low grade fever, cough, and wheezing with increasing difficulty breathing. Tachypnea develops and the child is transported to the hospital where hypoxia is noted on admission. The occupancy rate at the hospital is very high because of many similar cases. The child had a normal birth weight at 40 weeks gestation and was sent home with mother from the hospital on the second day following birth. The most probable etiology for these findings is:
A Adenovirus
B Legionella pneumophila
C Mycoplasma pneumoniae
D Respiratory syncytial virus
E Streptococcus pneumoniae
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Question 123 A thoracentesis is performed on a 54 year old female who has multiple lung masses. The pleural fluid obtained is serosanguinous. Cytologic examination of the fluid is most likely to demonstrate:
A Ferruginous bodies
B Cytomegalovirus
C Adenocarcinoma
D Lymphocytosis
E Polarizable crystals
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Question 124 Bronchoalveolar lavage yields a specimen with numerous alveolar macrophages that are filled with hemosiderin. The patient, a 48 year old female, has orthopnea. These findings are most likely to be a consequence of:
A Aspiration
B Mitral stenosis
C Blunt trauma
D Bronchiectasis
E Hepatic cirrhosis
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Question 125 After 25 days in hospital following a left cerebral infarction, a 67 year old male with a history of congestive heart failure has a sudden episode of pleuritic chest pain on the left. He had shown steady improvement up to that point, remaining afebrile. The most likely cause is:
A Lobar pneumococcal pneumonia
B Pulmonary infarction
C Left upper lobe abscess
D Bronchiectasis
E Cytomegalovirus pneumonitis
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